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Nursing’s leaders recognize a strong connection between a culturally diverse nursing workforce and the ability to provide quality, culturally competent patient care. Though nursing has made great strides in recruiting and graduating nurses that mirror the patient population, more must be done before adequate representation becomes a reality. The need to attract students from underrepresented groups in nursing – specifically men and individuals from African American, Hispanic, Asian, American Indian, and Alaskan native backgrounds - is a high priority for nursing profession.
Diversity in the Nursing Workforce & Student Population
- According to the U.S. Census Bureau, individuals from ethnic and racial minority groups accounted for more than one third of the U.S. population (38%) in 2014. With projections pointing to minority populations becoming the majority by 2043, professional nurses must demonstrate a sensitivity to and understanding of a variety of cultures to provide high quality care across settings.
- According to a 2017 survey conducted by the National Council of State Boards of Nursing (NCSBN) and The Forum of State Nursing Workforce Centers, nurses from minority backgrounds represent 19.2% of the registered nurse (RN) workforce. Considering racial/ethnic backgrounds, the RN population is comprised of 80.8% White/Caucasian; 6.2% African American; 7.5% Asian; 5.3% Hispanic; 0.4% American Indian/Alaskan Native; 0.5 Native Hawaiian/Pacific Islander; 1.7% two or more races; and 2.9% other nurses.
- The NCSBN survey also found that men now account for 9.1% of the RN workforce, which represents a 1.1% increase since 2015, When looking at specific nursing roles, the highest representation by men was in nurse anesthetist positions (41%).
- According to the 2008 National Sample Survey of Registered Nurses conducted by the U.S. Health Resources and Services Administration, RNs from minority backgrounds are more likely than their white counterparts to pursue baccalaureate and higher degrees in nursing. Data show that while 48.4% of white nurses complete nursing degrees beyond the associate degree level, the number is significantly higher or equivalent for minority nurses, including African American (52.5%), Hispanic (51.5%), and Asian (75.6%) nurses. RNs from minority backgrounds clearly recognize the need to pursue higher levels of nursing education beyond the entry-level.
- According to AACN's report on 2018-2019 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, nursing students from minority backgrounds represented 34.2% of students in entry-level baccalaureate programs, 34.7% of master’s students, 33.0% of students in research-focused doctoral programs, and 34.6% of Doctor of Nursing Practice (DNP) students. In terms of gender breakdown, men comprised 12.9% of students in baccalaureate programs, 12.2% of master’s students, 11.2% of research-focused doctoral students, and 13.4% of DNP students. Though nursing schools have made strides in recruiting and graduating nurses that reflect the patient population, more must be done before equal representation is realized.
Recognizing the Need to Enhance Diversity
- All national nursing organizations, the federal Bureau of Health Workforce hospital associations, nursing philanthropies, and other stakeholders within the health care community agree that recruitment of underrepresented groups into nursing is a priority for the nursing profession in the U.S.
- Nursing shortage reports, including those produced by the American Hospital Association, the Robert Wood Johnson Foundation (RWJF), the Joint Commission, and the Association of Academic Health Centers, point to minority student recruitment as a necessary step to addressing the nursing shortage.
- Besides adding new clinicians to the RN workforce, a diverse nursing workforce will be better equipped to serve a diverse patient population. According to a 2013 report by the National Advisory Council on Nurse Education and Practice, a diverse nursing workforce is essential for progress towards achieving health equity in the United States.
A groundbreaking report, titled Missing Persons: Minorities in the Health Professions, which was released by the Sullivan Commission on Diversity in the Healthcare Workforce in September 2004 stated: “The fact that the nation’s health professions have not kept pace with changing demographics may be an even greater cause of disparities in health access and outcomes than the persistent lack of health insurance for tens of millions of Americans. Today’s physicians, nurses, and dentists have too little resemblance to the diverse populations they serve, leaving many Americans feeling excluded by a system that seems distant and uncaring.”
Strategies to Enhance Diversity in Nursing Education
A lack of minority nurse educators may send a signal to potential students that nursing does not value diversity or offer career ladder opportunities to advance through the profession. Students looking for academic role models to encourage and enrich their learning may be frustrated in their attempts to find mentors and a community of support. Academic leaders are working to address this need by identifying minority faculty recruitment strategies, encouraging minority leadership development, and advocating for programs that remove barriers to faculty careers.
AACN, in collaboration with leading foundations and stakeholders, has taken the following steps to enhance diversity in nursing education:
- Launched in 2018, AACN formed the Diversity, Equity, and Inclusion Group (DEIG) to provide expert guidance to AACN and member schools on meeting strategic diversity goals. DEIG members work together to explore innovative approaches to enhancing diversity, equity, and inclusion in academic nursing and the nursing workforce. Group members share evidence-based practices, engage with the membership, convene networking forums, and mentor new diversity officers in nursing schools. As of March 2019, more than 55 individuals have joined the DEIG, which is seeking representatives from all schools of nursing.
- In 2016, AACN announced that it would provide a technical assistance program for schools seeking funding through the Nursing Workforce Diversity (NWD) program offered by the Health Resources and Services Administration. To receive funding, applicants were required to establish a formal agreement with a health professions organization to provide staff training related to Holistic Admissions Review. AACN moved quickly to develop a structured NWD Technical Assistance Program that features an assessment of admissions practices, an on-site Holistic Admissions Review workshop, student recruitment and retention strategies, and models for building a successful mentoring program. A total of 32 grant recipients in 19 states have executed contracts with AACN to complete the required training over the period of 4 years.
- In March 2017, AACN’s members voted to adopt the Position Statement on Diversity, Inclusion, and Equity in Academic Nursing. In this statement, AACN recognizes diversity, inclusion, and equity as critical to nursing education and fundamental to developing a nursing workforce able to provide high quality, culturally appropriate, and congruent health care in partnership with individuals, families, communities, and populations. The position further states that AACN is committed to preparing a community of scholars, clinicians, educators, and leaders who fully value the importance of diversity, inclusion, and equity to promote the health of the nation and the world.
- Since February 2018, AACN has partnered with the National Institute of Health to administer a mini-grants program to support the All of Us Research Program. This NIH initiative is working to extend precision medicine to all diseases by building a national research cohort of one million or more participants reflecting the diversity of the U.S. population. With a focus on schools serving communities that have been historically underrepresented in biomedical research (UBR), funding awarded through this program will be used to increase awareness of the program and the importance of participation of UBR members. To date, more than $215,000 in grant funding has been disbursed to 17 AACN member schools through this initiative.
- AACN collaborates with a variety of national nursing organizations to advocate for more federal funding for Nursing Workforce Development Programs, including funding for Nursing Workforce Diversity Grants. This program provides funding for projects to increase nursing education opportunities for individuals from disadvantaged backgrounds, including racial and ethnic minorities underrepresented among nurses.
- In 2013, AACN and the Robert Wood Johnson Foundation (RWJF) initiated the Doctoral Advancement in Nursing (DAN) Project to enhance the number of minority nurses completing PhD and DNP degrees. DAN’s expert committee developed a white paper featuring successful student recruitment and retention strategies that can be used by schools of nursing; comprehensive approaches to leadership and scholarship development for students; suggestions for model doctoral curriculum; and more. Though the DAN Project is no longer active, the resources created through this program, including a self-assessment for doctoral study and faculty and student tool kits to guide the process of gaining entry into doctoral programs, are still accessible online.
- In January 2010, AACN published a new set of competencies and an online faculty tool kit at the culmination of a national initiative funded by The California Endowment titled Preparing a Culturally Competent Master’s and Doctorally-Prepared Nursing Workforce. Working with an expert advisory group, AACN identified a set of expectations for nurses completing graduate programs and created faculty resources needed to develop nursing expertise in cultural competency. This work complemented a similar project for undergraduate programs which resulted in the publication of Cultural Competency in Baccalaureate Nursing Education and the posting of an online faculty toolkit.
- In 2008, the Robert Wood Johnson Foundation joined with AACN to launch the RWJF New Careers in Nursing (NCIN) Scholarship Program to help alleviate the nation’s nursing shortage by expanding the pipeline of students from minority backgrounds in accelerated nursing programs. Scholarships in the amount of $10,000 each were awarded to more than 3,000 nurses in entry-level baccalaureate and master’s programs through NCIN. Preference was given to students from groups underrepresented in nursing or from disadvantaged backgrounds. The NCIN program was sunset in 2017.
- AACN and the Johnson & Johnson Campaign for Nursing’s Future launched the Minority Nurse Faculty Scholars Program in 2007, which was modeled after a successful AACN collaboration with the California Endowment. In addition to $18,000 in scholarship funding, the program featured mentorship and leadership development components to assure successful completion of graduate studies and preparation for a faculty role. By the time the program closed in 2019, 63 scholars received funding through this program with many graduates now holding in teaching and leadership roles at schools nationwide.
Last Update: April 1, 2019
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